scholarly journals Exposure of the Calcaneus via the Sinus Tarsi Approach versus the Lateral Extensile Approach: A Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0039
Author(s):  
John C. Prather ◽  
John Wilson ◽  
Eildar Abyar ◽  
Sean Young ◽  
Gerald McGwin ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Lateral Wall ◽  
Cadaveric Study ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Articular Surfaces ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Fresh Frozen ◽  
Extensile Approach

Category: Hindfoot; Trauma Introduction/Purpose: The lateral extensile approach (LEA) to the calcaneus has long been a popular surgical approach to treat calcaneal fractures. However, high rates of wound complications have led surgeons to investigate alternative approaches. As a result, the sinus tarsi approach has grown in popularity. The lateral extensile approach affords substantial visualization of the calcaneus. However, this visualization has never been compared in a quantitative manner to the sinus tarsi approach (STA). The objective of this cadaveric study is to compare calcaneal visualization afforded by a sinus tarsi approach and a lateral extensile approach. Methods: Seven pair-matched, fresh-frozen, below-knee cadaver specimens were obtained. For each pair, one side received an LEA and the other side received a STA. To identify areas of the calcaneus accessible by instrument, a curette was used to mark the visualized calcaneal surfaces. The calcaneus was then disarticulated and cleared of all soft tissue. The curette markings were then identified and marked with blue surgical marker. Photos were taken of each calcaneus, and visualized surface areas were calculated using Image J software. Results: There were no statistically significant differences in the articular surfaces accessible between the two approaches (831.99 mm2 for LEA vs. 903.41 mm2 for STA, p=0.53) including the anterior, middle, and posterior facets. The total calcaneal surface area accessible was 3107.08 mm2 for LEA and 1444.19 mm2 for STA (p=0.02). The LEA allowed better exposure to the lateral wall (p<0.01) and superior greater tuberosity of the calcaneus (p=0.05). Conclusion: In comparison to the LEA, the STA allows for equivalent exposure to articular surfaces. While the LEA allows for greater exposure of the lateral wall and posterior tuberosity, direct visualization of these structures may not warrant the higher risk of wound complications. Surgeons should be mindful of these differences when choosing a surgical approach in the treatment of calcaneal fractures.

scholarly journals Sinus Tarsi Approach for Open Treatment and Internal Fixation of Displaced Intra-articular Calcaneal Fractures in High-Risk Patients: The New Gold Standard?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
James P. Davies ◽  
W. Bret Smith ◽  
Steven Steinlauf ◽  
Mary Millikin
Keyword(s):  
High Risk ◽  
Gold Standard ◽  
Wound Complication ◽  
Lateral Approach ◽  
Wound Complications ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach

Category: Ankle, Diabetes, Hindfoot, Trauma Introduction/Purpose: Intra-articular calcaneal fractures offer unique challenges. Wound problems and infection are significant complications in the surgical treatment of calcaneal fractures which in turn can be debilitating to patients and outcomes. The literature suggests varying wound complication rates but 21% up to 33% using the traditional extensile lateral approach in some studies. The extensile lateral approach has historically been accepted as the gold standard for fixation and treatment of these fractures. Recently there has been resurgent interest in alternative approaches to the fixation of intra-articular calcaneal fractures. Of interest is the potential of the sinus tarsi approach to decrease wound complications while having comparable reduction quality to the higher wound risk extensile lateral approach. Methods: A multi-center retrospective chart review study was implemented. The study objective was to review wound complication of the sinus tarsi approach compared with outcomes from the traditional extensile approach for fixation of displaced intra-articular calcaneal fractures. Specifically; examining a population of patients considered at high risk for wound issues, comparing radiographic and clinical outcomes. Results: In the high-risk group, only one primary complications resulted, including one patient with a history of an open fracture. All fractures healed with adequate maintenance of alignment. Chi- squared analysis resulted in a statistically significant difference in complication rates between sinus tarsi and the traditional extensile lateral approach at the 95% confidence level. Conclusion: In both high-risk and lower-risk cohorts of patients, a low rate of infection and wound problems was encountered. A limited approach through a sinus tarsi incision provides a viable option to treat displaced intra-articular calcaneus fracture patients with risk factors for wound issues. The patients all healed both their soft tissue wounds and fractures. Functional return was consistent with other study populations. Our study adds another cohort of patient data demonstrating the advantage of the sinus tarsi approach when compared to the extensile lateral in terms of decreased wound complications while maintaining quality of reductions and clinical outcomes.

Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture

2021 ◽  
pp. 1-8
Author(s):  
Chul Hyun Park ◽  
Hongfei Yan ◽  
Jeongjin Park
Keyword(s):  
Comparative Study ◽  
Subtalar Joint ◽  
Short Form ◽  
Operation Time ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Aofas Score ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

Aims No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. Methods Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of movement (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction. Results Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). Conclusion The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant.

scholarly journals Use of the Extended Sinus Tarsi Approach for Treatment of Displaced Intra-articular Calcaneal Fractures Compared with the Extended Lateral Approach

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0027
Author(s):  
Chan Kang ◽  
Dong Yeol Kim ◽  
Jae-Hwang Song ◽  
Jeong-kil Lee ◽  
Seokhwan Song ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Lateral Approach ◽  
Wound Complications ◽  
Pain Patient ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Patient Reported ◽  
Extended Lateral Approach

Category: Trauma Introduction/Purpose: We compared the radiographic results and clinical outcomes of patients with displaced, intra-articular calcaneal fractures treated via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA). Methods: We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated upon between January 2009 and September 2014. We evaluated pre- and post-operative X-rays and computed tomography (CT) data. Pain, patient-reported functional outcomes, patient satisfaction, and postoperative complications, were investigated at the three year follow-up. Results: Neither the postoperative nor three year follow-up Böhler angles, nor the calcaneal width, differed significantly between the two groups (both p > 0.05). The maximum step-off of the posterior facet on the three month CT follow-up of the ESTA was significantly less than that of the ELA (p < 0.05). We found no significant between-group differences in terms of postoperative translation (p = 0.232) or angulation of the sustentacular fragment (p = 0.132), three year follow-up mean visual analog scale pain score at rest (p = 0.641) or during weight-bearing (p = 0.525), Foot Function Index (FFI) (p = 0.712), and self-reported satisfaction (p = 0.823). The ELA experienced significantly more wound complications (p = 0.039) and nonunions (p = 0.014) than the ESTA. Conclusion: Compared with the ELA, the ESTA afforded comparable radiological results and clinical outcomes, associated with a reduced operative time and fewer wound complications and nonunions. We suggest that the ESTA is an efficient surgical option when treating displaced, intra-articular calcaneal fractures.

scholarly journals Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091528 ◽  
Author(s):  
Tao Yu ◽  
Yuan Xiong ◽  
Alex Kang ◽  
Haichao Zhou ◽  
Wenbao He ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lateral Approach ◽  
Cochrane Library ◽  
Wound Complications ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach ◽  
Meta Analyses

Purpose: Accumulated literature has reported the comparative efficacy of the sinus tarsi approach (STA) and the extensile lateral approach (ELA) for the treatment of calcaneal fractures (CFs). However, the best alternative treatment for CF is still inconsistent. Herein, the present systematic review of overlapping meta-analyses aims to achieve an evident conclusion by performing a comprehensive reanalysis of previous meta-analyses regarding the comparison of the STA and the ELA. Methods: We searched several databases, including Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov , OVID, and CNKI for the meta-analyses comparing the STA and the ELA for the treatment of CF. All related meta-analyses of randomized controlled trials and cohort studies were included. Two researchers independently assessed the quality of the articles and extracted the data. The Jadad decision algorithm was used to evaluate the evidence of the articles. Results: Ultimately, five meta-analyses were included in the present study. The Assessment of Multiple Systematic Reviews scores of these articles ranged from 5 to 9 with a median of 7. The analysis of best quality, Bai 2018, was selected based on the Jadad algorithm. In this article, the significant differences were found in wound complications and operating time, recovery of Böhler’s angle, the American Orthopaedic Foot and Ankle Society scores, and the visual analog scale. Conclusion: The clinical relevance of the present study is that both the STA and the ELA are effective in alleviating pain and improving functionality in the treatment of CF. However, due to a shorter operation duration and lower complication rates, the STA was indicated to be a superior alternative for CF treatment.

Extended Sinus Tarsi Approach for Treatment of Displaced Intraarticular Calcaneal Fractures Compared to Extended Lateral Approach

2018 ◽  
Vol 40 (2) ◽  
pp. 167-177 ◽  
Author(s):  
Jae Hwang Song ◽  
Chan Kang ◽  
Deuk Soo Hwang ◽  
Dong Hun Kang ◽  
June Woo Park
Keyword(s):  
Clinical Outcomes ◽  
Lateral Approach ◽  
Wound Complications ◽  
Pain Patient ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Patient Reported ◽  
Extended Lateral Approach

Background: We compared the radiographic results and clinical outcomes of patients operated on via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA) for treatment of displaced intraarticular calcaneal fractures. Methods: We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated on between January 2009 and March 2015. We evaluated pre- and postoperative x-rays and computed tomography (CT) data. Pain, patient-reported functional outcomes, satisfaction, and postoperative complications were investigated at the 3-year follow-up. Results: Neither the postoperative nor 3-year follow-up Böhler angles, nor the calcaneal width, differed significantly between the 2 groups (both P > .05). However, the maximum step-off of the posterior facet on the 3-month CT follow-up of the ESTA group was significantly less than that of the ELA group ( P < .05). We found no significant between-group differences in terms of postoperative translation ( P = .232) or angulation ( P = .132) of the sustentacular fragment on the 3-month CT follow-up. At the 3-year follow-up, we found no significant between-group difference in the mean visual analog scale pain score at rest ( P = .641) or during weightbearing ( P = .525). We found no significant between-group difference in the Foot Function Index (FFI) ( P = .712) or self-reported satisfaction ( P = .823). The ELA group experienced significantly more wound complications ( P = .041) and nonunions ( P = .041) than the ESTA group. Four instances of superficial peroneal nerve injury were reported in the ESTA group ( P = .127). Conclusion: Compared with the ELA, the ESTA afforded comparable, favorable radiological results and clinical outcomes, associated with fewer wound complications and nonunions. We suggest that the ESTA is an effective operative option when treating displaced, intraarticular calcaneal fractures. Level of Evidence: Level III, comparative study.

scholarly journals Steinmann pin retractor-assisted reduction with circle plate fixation via sinus tarsi approach for intra-articular calcaneal fractures: a retrospective cohort study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Bin Zhao ◽  
Wenqian Zhao ◽  
Isaac Assan
Keyword(s):  
Plate Fixation ◽  
Lateral Wall ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Anatomic Reduction ◽  
Sinus Tarsi Approach ◽  
American Orthopaedic ◽  
Calcaneus Fractures ◽  
Steinmann Pin

Abstract Background Sinus tarsi approach and mini-calc plate have been used for intra-articular calcaneal fractures. However, the sinus tarsi approach has limited exposure to the lateral wall, which makes it challenging to obtain an excellent anatomic reduction of the calcaneal body. What is more! To restore the width of the calcaneal body entirely and prevent the heel varus simultaneously with mini-calc plate was tough as well. Aimed to solve the aforementioned problems, our study focused on using the Steinmann pin retractor for reduction and the circle plate for fixation via the sinus tarsi approach. Methods From March 2017 to January 2019, 15 patients with closed calcaneal fractures were treated with the method of Steinmann pin retractor-assisted reduction and circle plate fixation via the sinus tarsi approach. All these patients received a positive postoperative clinical and radiological evaluation. Results A postoperative follow-up was done for each of the 15 patients, and the following scores and parameters were observed: value of visual analogue scale (VAS) was 1.44 ± 0.63, and The American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot score was 84.31 ± 5.03 at the last follow-up. The Böhler angle (30.81 ± 3.56°), width (37.83 ± 4.87 mm), length (87.4 ± 3.33 mm), and height (86.23 ± 5.36 mm) of the calcaneus were improved significantly in comparison with preoperative values (− 0.94 ± 10.06°, 45.67 ± 5.68 mm, 82.72 ± 5.54 mm, 76.32 ± 7.98 mm), and these parameters were maintained excellently after 6–19 months’ follow-up. Conclusion Our present study suggested that Steinmann pin retractor-assisted reduction with circle plate fixation via the sinus tarsi approach may serve as a safe and effective method for Sanders type II and type III calcaneus fractures. The Böhler angle, height, length, and body of the calcaneus were excellently restored postoperatively and maintained at last follow-up and rare postoperative complications. Trial registration This study has been registered. The unique identifying number is research registry 5092.

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